<?php
/**
 * Patient Signal form 2. Used in create and update action in PatientSignalController.
 *
 * @package   views
 * @subpackage patientSignal
 * @since     1.0
 * @filesource
 */
?>
	<div class="row">
		<?php echo $form->labelEx($model,'currentMedicationAndDosage'); ?>
		<?php echo $form->textArea($model,'currentMedicationAndDosage',array('rows'=>6, 'cols'=>50)); ?>
		<?php echo $form->error($model,'currentMedicationAndDosage'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'reportedSideEffects'); ?>
		<?php echo $form->textArea($model,'reportedSideEffects',array('rows'=>6, 'cols'=>50)); ?>
		<?php echo $form->error($model,'reportedSideEffects'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'pastMedicationHistory'); ?>
		<?php echo $form->textArea($model,'pastMedicationHistory',array('rows'=>6, 'cols'=>50)); ?>
		<?php echo $form->error($model,'pastMedicationHistory'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'lastDoseTakenTime'); ?>
		<?php echo $form->hiddenField($model,'lastDoseTakenTime'); ?>
		<?php
			$this->widget('zii.widgets.jui.CJuiDatePicker', array(
		    	'name'=>'dobSelect',
		    	'options'=>array(
					'altField'=>'#'.CHtml::activeId($model, "lastDoseTakenTime"),	
		    	),
		    	'value'=>$model->lastDoseTakenTime?$model->lastDoseTakenTime:'',	
			));
		?>
		<?php echo $form->error($model,'lastDoseTakenTime'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'otherTherapyDescription'); ?>
		<?php echo $form->textArea($model,'otherTherapyDescription',array('rows'=>6, 'cols'=>50)); ?>
		<?php echo $form->error($model,'otherTherapyDescription'); ?>
	</div>